Dosage Study And Prognosis Analysis Of Re-radiotherapy For Local Recurrence After Definitive Radiotherapy For Esophageal Cancer

ObjectivePatients with esophageal squamous cell carcinoma who had local recurrence after radical radiotherapy and received re-radiotherapy were enrolled to observe and analyze their basic clinical characteristics,adverse reactions,short-term efficacy and long-term survival,and to explore the optimal dose of re-radiotherapy and the relationship between various clinical factors and prognosis.MethodsThe medical records of all patients with esophageal cancer admitted to the Radiotherapy Department of Shaanxi Cancer Hospital from January 2010 to December2020 were reviewed,and the patients who met the criteria of re-radiotherapy were screened out.The basic clinical data,the first stage data,the second stage data and the follow-up data were observed and analyzed.According to the different dose of re-radiotherapy,the patients were divided into low-dose group: ≥40Gy,<54Gy,high-dose group: ≥54Gy,≤66Gy.The clinical data,incidence of adverse reactions and short-term efficacy were compared between the groups by χ2 test or Fisher’s exact probability method.Univariate analysis was performed by Kaplan-Meier method to calculate the survival rate and plot the survival curve.Log-rank test was used to test the survival difference between the groups,Cox proportional risk model was used for multivariate analysis.ResultsA total of 65 patients who met the entry and discharge criteria of re-radiotherapy were screened out,and 4 patients were lost to follow-up,with a follow-up rate of 94%.By the end of the follow-up on December 31,2020,one patient had survived.1.Basic clinical dataAmong the 65 patients who completed re-radiotherapy,50 were males and 15 were females.The age of recurrence ranged from 47 to 88 years old,with a median age of 66 years old.The re-radiotherapy dose was 40-66 Gy,and the median dose was 54 Gy.The overall survival time ranged from 2 to 68 months,the median survival time was 10 months,and the 1,2 and 3 year survival rates were 40.1%,17.7% and 8.2%.2.Adverse reactionThe adverse reaction rate in the high-dose group(n=36)was higher than that in the low-dose group(n=29),but there was no statistical difference(P>0.05).3.Short-term efficacyThe complete response rate,partial response rate and total response rate of the high-dose group(n=36)were all higher than those of the low-dose group(n=29),there was a statistical difference in the total response rate between the two groups(P=0.002).4.Univariate analysisAge(P=0.012),re-course clinical stage(P<0.001),re-course radiotherapy dose(P=0.001)and response rate(P<0.001)were the factors affecting the survival and prognosis of patients.However,sex(P=0.341),the time between recurrence(P=0.355),re-course KPS(P=0.642),weight loss(P=0.857),re-course lesion segment(P=0.620),re-course lesion length(P=0.574),re-course treatment(P=0.353),re-course radiotherapy(P=0.879),recurrence nature(P=0.415),radiothermitis(P=0.669),radiation esophagitis(P=0.390),radiation pneumonia(P=0.070),myeloid suppression(P=0.902),lemostenosis(P=0.901)and perforation(P=0.934)were not associated with survival prognosis.5.Multivariate analysisCox multivariate analysis showed that the dose of re-radiotherapy(P=0.046),clinical stage of re-radiotherapy(P=0.044)and response rate(P<0.001)were independent factors affecting the survival and prognosis of patients.Conclusions1.It is feasible for local recurrence of esophageal cancer after radical radiotherapy,dose ≥54Gy and ≤66Gy were appropriate,the short-term efficacy and long-term survival of patients were beneficial,and the adverse reactions were tolerable.2.The prognosis of re-radiotherapy for esophageal cancer is related to age,re-radiotherapy stage,re-radiotherapy dose,and short-term efficacy.3.Patients with esophageal cancer should be rechecked regularly after the end of the first radiotherapy.If recurrence occurs,early diagnosis and treatment should be performed.When the patient can tolerate adverse reactions,high dose radiotherapy’s effect is better.The survival of patients with CR or PR in the short term was better than that of patients with NR,which could be used to evaluate long-term survival.